Abstract | OBJECTIVE: DESIGN: Case report. SETTING: University-based referral center for autonomic dysfunction. PATIENT: INTERVENTION: MAIN OUTCOME MEASURES: RESULTS: Treatment with rituximab followed by plasma exchange significantly decreased the nAChR antibody titers for a short time, and then the titers increased. The titers suppressed to almost undetectable levels once regular maintenance therapy with rituximab was initiated. Reduction in nAChR antibody titer resulted in a decrease in orthostatic hypotension, an increased concentration of upright plasma norepinephrine, improvement in some sweat function, and improvement in symptoms. CONCLUSIONS: Long-term rituximab therapy suppressed autoantibody production to undetectable levels over the course of 2 years and resulted in sustained clinical improvement in this patient with debilitating autoimmune autonomic ganglionopathy. More data are needed before rituximab therapy can be recommended as routine therapy for this disorder.
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Authors | Ryan Hollenbeck, Bonnie K Black, Amanda C Peltier, Italo Biaggioni, David Robertson, Elliott F Winton, Satish R Raj |
Journal | Archives of neurology
(Arch Neurol)
Vol. 68
Issue 3
Pg. 372-5
(Mar 2011)
ISSN: 1538-3687 [Electronic] United States |
PMID | 21059985
(Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents
- Autoantibodies
- Receptors, Nicotinic
- Rituximab
- Norepinephrine
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Topics |
- Aged
- Antibodies, Monoclonal, Murine-Derived
(therapeutic use)
- Antineoplastic Agents
(therapeutic use)
- Autoantibodies
(analysis, immunology)
- Autoimmune Diseases of the Nervous System
(complications, drug therapy, therapy)
- Autonomic Nervous System Diseases
(complications, drug therapy, therapy)
- Blood Pressure
(physiology)
- Female
- Ganglia, Autonomic
- Humans
- Hypotension, Orthostatic
(etiology)
- Lymphoma, B-Cell
(complications)
- Norepinephrine
(blood)
- Plasma Exchange
- Receptors, Nicotinic
(immunology)
- Rituximab
- Sweating
(physiology)
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